title: Comparison of robotic and laparoscopic hysterectomy for benign gynecologic disease.
abstract: OBJECTIVE
  Use of robotically assisted hysterectomy for benign gynecologic conditions is increasing. Using the most recent, available nationwide data, we examined clinical outcomes, safety, and cost of robotic compared with laparoscopic hysterectomy.
  
  
  METHODS
  Women undergoing robotic or laparoscopic hysterectomy for benign disease were identified from the United States 2009 and 2010 Nationwide Inpatient Sample. Propensity scores derived from a logistic regression model were used to assemble matched cohorts of patients undergoing robotic and laparoscopic hysterectomy. Differences in in-hospital complications, hospital length of stay, and hospital charges were assessed between the matched groups.
  
  
  RESULTS
  Of the 804,551 hysterectomies for benign conditions performed in 2009 and 2010, 20.6% were laparoscopic and 5.1% robotically assisted. Among minimally invasive hysterectomies, the use of robotic hysterectomy increased from 9.5% to 13.6% (P=.002). In a propensity-matched analysis, the overall complication rates were similar between robotic and laparoscopic hysterectomy (8.80% compared with 8.85%, relative risk 0.99, 95% confidence interval [CI] 0.89-1.09, P=.910). There was a lower incidence of blood transfusions in robotic cases (2.1% compared with 3.1%; P<.001), but patients undergoing robotic hysterectomy were more likely to experience postoperative pneumonia (relative risk 2.2, 95% CI 1.24-3.78, P=.005). The median cost of hospital care was $9,788 (interquartile range $7,105-12,780) for robotic hysterectomy and $7,299 (interquartile range $5,650-9,583) for laparoscopic hysterectomy (P<.001). Hospital costs were on average $2,489 (95% CI $2,313-2,664) higher for patients undergoing robotic hysterectomy.
  
  
  CONCLUSIONS
  The use of robotic hysterectomy has increased. Perioperative outcomes are similar between laparoscopic and robotic hysterectomy, but robotic cases cost substantially more.
  
  
  METHODS
  : II.
authors.affiliation: Departments of Anesthesiology and Pain Management and Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rosero
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Kho
authors.forename: Girish P
authors.initials: GP
authors.lastname: Joshi
authors.forename: Martin
authors.initials: M
authors.lastname: Giesecke
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Schaffer
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D008875:Middle Aged; D012371:Robotics; D016896:Treatment Outcome; D055815:Young Adult